Laura
11-09-2009, 11:51 PM
Action Alert: NCIL Officially Endorses the Affordable Health Care
for America Act: Your Help is Needed to Ensure Passage!]
Action Alert: NCIL Officially Endorses the Affordable Health Care for America Act: Your Help is Needed to Ensure Passage!
NCIL is proud to announce its support for HR 3962, the Affordable Health Care for America Act of 2009! Many of our priorities are included as provisions in this bill, and NCIL urges its membership to call their Representatives by telephone and urge them to vote YES on HR 3962!
The House of Representatives is expected to debate and take an historic vote on HR 3962 TOMORROW, Saturday, November 7th. Your calls are needed TODAY!
Tell them that you support HR 3962 because of the multitude of beneficial provisions for people with disabilities and remind them that HR 3962 contains the Sense of Congress provision in the Manager’s Amendment that supports the inclusion of the Community First Choice Option in the final healthcare reform bill.
Here is a snapshot of the programs that significantly or directly impact people with disabilities.
1. Immediate Reforms. This section sets new standards for existing health insurance plans
a. National High Risk Pool Program: This is a temporary insurance pool that will cover individuals without public or employer-provided health insurance who have been denied coverage, have had their coverage rescinded because of a pre-existing condition, or are enrolled in a high risk plan where the premiums are higher than those in this pool.
b. Prohibition of rescission of coverage and guaranteed renewability of coverage in the small group market: This will be in place until the new rules of the health insurance exchange take effect, which also prohibit rescission of coverage.
c. Limitations on discrimination pre-existing condition exclusions from healthcare coverage: This will be in place until the new rules of the health insurance exchange take effect, which also prohibit pre-existing discrimination exclusions.
d.Elimination of lifetime limits on coverage. There may not be a dollar limit on the benefits paid out by a plan in the group exchange.
2. Protections and Standards of Health Benefit Plans
a. Prohibition of pre-existing condition exclusions: A qualified health insurance plan may not impose any pre-existing condition exclusion, or impose conditions or limits of coverage based on health status, medical condition, previous claims, medical history, genetic information, disability or source of injury.
b. Guaranteed issue and renewal of health insurance plans; prohibition of rescission of the plans: This will apply to individuals in the health insurance exchange and to individuals who get their insurance through an employer.
c. Nondiscrimination of health benefits, Parity in Mental Health and Substance Abuse benefits in individual and small group market plans.
3. Coverage of Essential Benefits in Health Plans
a. Hospitalization
b. Outpatient Hospital, Clinic and Emergency Services
c. Physician Services
d. Prescription Drugs
e. Rehabilitative and Habilitative Services
f. Mental Health and Substance Abuse Disorder Treatments
g. Preventative Care – no cost sharing
h. Durable Medical Equipment, Prosthetics, Orthotics and Supplies
i. Maternity and Well-Baby Care
4. Public Insurance Option: This is the public option that has been so hotly debated. This plan will follow the same rules that the private plans in the health insurance exchange offer, as well as the same benefits as listed above.
5. Affordability Credits
a. These credits will assist people who purchase their insurance through the health insurance exchange, and will go towards the cost of the premiums.
b. There will also be cost-sharing credits to assist with out-of-pocket costs such as deductibles and co-pays.
c. A determination will be made to determine financial eligibility for these credits.
d.There are also credits in year two of enactment of this legislation that provide credits to employees whose employer-provided coverage has premiums that exceed 12% of the employees modified adjusted gross income.
6. The CLASS Act: The CLASS Act was included in the House bill, which is a major victory for NCIL and the over 100 other aging and disability organizations that have been supporting it. There are some differences between the two bills, but we expect a solid long-term care insurance program to emerge.
7. Medicare Part B Reforms
a. Rental and purchase of power-driven wheelchairs: This bill eliminates the first month purchase option for all chairs with the exception of complex rehabilitative power wheelchairs. At the end of the 13-month rental period, the beneficiary would have the option to purchase the power chair or return the chair, with the ability to have access to the equipment as needed.
b. Competitive Bidding Program –NCIL has been opposed to this program, and this bill requires the Office of the Inspector General to establish and evaluate a competitive bidding program for manufacturers of durable medical equipment.
c.Bundling of post-acute care payments. This bill requires the Secretary of Health and Human Services to create a plan to implement a bundling program for post-acute care services. The goal is better coordination of care after release in order to prevent readmissions.
8.Medicare Part D Reforms
a. The bill reduces the size of the coverage gap or “doughnut hole” by $500 in 2010, and continues to reduce the size until phased out by the year 2019.
b.The bill also includes rebates by drug manufacturers that reduce the out of pocket expenses for beneficiaries by 50% for brand name drugs. This will not adversely affect the doughnut hole for beneficiaries.
9. General Medicare Improvements: The bill eliminates cost-sharing for preventive services in Medicare
10. Nursing Facility Accountability Requirements
a. This legislation requires nursing facilities and skilled nursing facilities to create compliance and ethics programs within three years of enactment.
b. The bill requires the Secretary to create a standardized complaint form and complaint resolution process
11. Medicaid Reform
a.HR 3962 requires state Medicaid programs to cover non-disabled childless adults under the age of 65 up to 150% of the Federal Poverty Level. The federal government will reimburse states for 100% of the cost of the newly-eligible enrollees, and then 91% starting in 2015, and from that point forward. This covers parents and children who fall in the same eligibility range.
b. The legislation requires states to maintain eligibility requirements.
c.The bill requires state Medicaid programs to cover preventive services, as prescribed by the U.S. Preventive Services Taskforce.
d.Improved coordination of beneficiaries who are “dual-eligible” for Medicare and Medicaid. This bill requires CMS to establish a dedicated office or program to the coordination of these benefits.
12. Accessibility Standards of Medical and Diagnostic Equipment
a. This bill requires that within nine months, the Access Board create minimum standards for new medical equipment purchased for doctor’s offices, clinics, hospitals, emergency rooms and other medical settings. The standards will guarantee independent entry, use and exit of such equipment by individuals with disabilities.
b. The legislation extends to diagnostic equipment such as exam tables and chairs (also includes equipment for dental exams), weight scales, mammography equipment, x-ray machines and other common diagnostic equipment.
13. Long-Term Care and Family Caregiver Support: This legislation creates an advisory panel and a pilot program focused on improving training and working conditions for the long-term care workforce
14. Manager’s Amendment: This is an amendment that contains several provisions HR 3962. Amongst its 42 pages is what is called a “Sense of Congress” to support the inclusion of the Community First Choice Option in the final healthcare reform legislation. While this is not the actual language of the CFC it is significant because it demonstrates Congress’ intent to include the CFC in the final healthcare bill. The reason for the Sense of Congress instead of actual legislative language is that the bill won’t have to be rescored, so they can stick to an aggressive timetable.
If you have questions about HR 3962, or about healthcare reform in general, contact NCIL Policy Analyst, Jason Beloungy, at 202-207-0334 (toll-free: 1-877-525-3400), ext.1008. Jason can also be reached by e-mail at: jason@nci.org.
__._,_.___
for America Act: Your Help is Needed to Ensure Passage!]
Action Alert: NCIL Officially Endorses the Affordable Health Care for America Act: Your Help is Needed to Ensure Passage!
NCIL is proud to announce its support for HR 3962, the Affordable Health Care for America Act of 2009! Many of our priorities are included as provisions in this bill, and NCIL urges its membership to call their Representatives by telephone and urge them to vote YES on HR 3962!
The House of Representatives is expected to debate and take an historic vote on HR 3962 TOMORROW, Saturday, November 7th. Your calls are needed TODAY!
Tell them that you support HR 3962 because of the multitude of beneficial provisions for people with disabilities and remind them that HR 3962 contains the Sense of Congress provision in the Manager’s Amendment that supports the inclusion of the Community First Choice Option in the final healthcare reform bill.
Here is a snapshot of the programs that significantly or directly impact people with disabilities.
1. Immediate Reforms. This section sets new standards for existing health insurance plans
a. National High Risk Pool Program: This is a temporary insurance pool that will cover individuals without public or employer-provided health insurance who have been denied coverage, have had their coverage rescinded because of a pre-existing condition, or are enrolled in a high risk plan where the premiums are higher than those in this pool.
b. Prohibition of rescission of coverage and guaranteed renewability of coverage in the small group market: This will be in place until the new rules of the health insurance exchange take effect, which also prohibit rescission of coverage.
c. Limitations on discrimination pre-existing condition exclusions from healthcare coverage: This will be in place until the new rules of the health insurance exchange take effect, which also prohibit pre-existing discrimination exclusions.
d.Elimination of lifetime limits on coverage. There may not be a dollar limit on the benefits paid out by a plan in the group exchange.
2. Protections and Standards of Health Benefit Plans
a. Prohibition of pre-existing condition exclusions: A qualified health insurance plan may not impose any pre-existing condition exclusion, or impose conditions or limits of coverage based on health status, medical condition, previous claims, medical history, genetic information, disability or source of injury.
b. Guaranteed issue and renewal of health insurance plans; prohibition of rescission of the plans: This will apply to individuals in the health insurance exchange and to individuals who get their insurance through an employer.
c. Nondiscrimination of health benefits, Parity in Mental Health and Substance Abuse benefits in individual and small group market plans.
3. Coverage of Essential Benefits in Health Plans
a. Hospitalization
b. Outpatient Hospital, Clinic and Emergency Services
c. Physician Services
d. Prescription Drugs
e. Rehabilitative and Habilitative Services
f. Mental Health and Substance Abuse Disorder Treatments
g. Preventative Care – no cost sharing
h. Durable Medical Equipment, Prosthetics, Orthotics and Supplies
i. Maternity and Well-Baby Care
4. Public Insurance Option: This is the public option that has been so hotly debated. This plan will follow the same rules that the private plans in the health insurance exchange offer, as well as the same benefits as listed above.
5. Affordability Credits
a. These credits will assist people who purchase their insurance through the health insurance exchange, and will go towards the cost of the premiums.
b. There will also be cost-sharing credits to assist with out-of-pocket costs such as deductibles and co-pays.
c. A determination will be made to determine financial eligibility for these credits.
d.There are also credits in year two of enactment of this legislation that provide credits to employees whose employer-provided coverage has premiums that exceed 12% of the employees modified adjusted gross income.
6. The CLASS Act: The CLASS Act was included in the House bill, which is a major victory for NCIL and the over 100 other aging and disability organizations that have been supporting it. There are some differences between the two bills, but we expect a solid long-term care insurance program to emerge.
7. Medicare Part B Reforms
a. Rental and purchase of power-driven wheelchairs: This bill eliminates the first month purchase option for all chairs with the exception of complex rehabilitative power wheelchairs. At the end of the 13-month rental period, the beneficiary would have the option to purchase the power chair or return the chair, with the ability to have access to the equipment as needed.
b. Competitive Bidding Program –NCIL has been opposed to this program, and this bill requires the Office of the Inspector General to establish and evaluate a competitive bidding program for manufacturers of durable medical equipment.
c.Bundling of post-acute care payments. This bill requires the Secretary of Health and Human Services to create a plan to implement a bundling program for post-acute care services. The goal is better coordination of care after release in order to prevent readmissions.
8.Medicare Part D Reforms
a. The bill reduces the size of the coverage gap or “doughnut hole” by $500 in 2010, and continues to reduce the size until phased out by the year 2019.
b.The bill also includes rebates by drug manufacturers that reduce the out of pocket expenses for beneficiaries by 50% for brand name drugs. This will not adversely affect the doughnut hole for beneficiaries.
9. General Medicare Improvements: The bill eliminates cost-sharing for preventive services in Medicare
10. Nursing Facility Accountability Requirements
a. This legislation requires nursing facilities and skilled nursing facilities to create compliance and ethics programs within three years of enactment.
b. The bill requires the Secretary to create a standardized complaint form and complaint resolution process
11. Medicaid Reform
a.HR 3962 requires state Medicaid programs to cover non-disabled childless adults under the age of 65 up to 150% of the Federal Poverty Level. The federal government will reimburse states for 100% of the cost of the newly-eligible enrollees, and then 91% starting in 2015, and from that point forward. This covers parents and children who fall in the same eligibility range.
b. The legislation requires states to maintain eligibility requirements.
c.The bill requires state Medicaid programs to cover preventive services, as prescribed by the U.S. Preventive Services Taskforce.
d.Improved coordination of beneficiaries who are “dual-eligible” for Medicare and Medicaid. This bill requires CMS to establish a dedicated office or program to the coordination of these benefits.
12. Accessibility Standards of Medical and Diagnostic Equipment
a. This bill requires that within nine months, the Access Board create minimum standards for new medical equipment purchased for doctor’s offices, clinics, hospitals, emergency rooms and other medical settings. The standards will guarantee independent entry, use and exit of such equipment by individuals with disabilities.
b. The legislation extends to diagnostic equipment such as exam tables and chairs (also includes equipment for dental exams), weight scales, mammography equipment, x-ray machines and other common diagnostic equipment.
13. Long-Term Care and Family Caregiver Support: This legislation creates an advisory panel and a pilot program focused on improving training and working conditions for the long-term care workforce
14. Manager’s Amendment: This is an amendment that contains several provisions HR 3962. Amongst its 42 pages is what is called a “Sense of Congress” to support the inclusion of the Community First Choice Option in the final healthcare reform legislation. While this is not the actual language of the CFC it is significant because it demonstrates Congress’ intent to include the CFC in the final healthcare bill. The reason for the Sense of Congress instead of actual legislative language is that the bill won’t have to be rescored, so they can stick to an aggressive timetable.
If you have questions about HR 3962, or about healthcare reform in general, contact NCIL Policy Analyst, Jason Beloungy, at 202-207-0334 (toll-free: 1-877-525-3400), ext.1008. Jason can also be reached by e-mail at: jason@nci.org.
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